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Anti-infective drugs, pregnancy, Quebec Pregnancy Registry, trends
Development of knowledge in understanding the use of anti-infective drugs during pregnancy has been limited by difficulties in testing medications in pregnant women and lack of evidence-based data. Overuse of broad spectra agents is associated with development and spread of bacterial resistance, a problem that is faced as a significant threat to the public health.
To describe trends in use of general and broad spectrum anti-infective drugs during pregnancy.
We used the Quebec Pregnancy Registry to analyse trends for use of oral anti-infectives dispensed during pregnancy for the five-year period comprised between January 1998 and December 2002. Trends in use were assessed for classes of anti-infectives and for broad-spectrum drugs. Descriptive statistics were used to summarize the characteristics of the study population. Annual trends for the use of anti-infective drugs were analyzed using the Cochran-Armitage test.
The use of anti-infective drugs and broad spectrum agents during pregnancy decreased from 1998 to 2002 (p ≤ 0.05 for trends). The classes that showed increasing trend for use were: macrolides, quinolones, tetracyclines, urinary anti-infective drugs and antimycotics. Use of penicillins and sulfonamides decreased. Azithromycin showed a remarkable increase in its use: 0.04% of all anti-infective prescriptions in 1998, compared to 10.16% in 2002.
Decrease in the use of broad-spectrum drugs may have been caused by a positive impact of data issued from evidence in everyday life clinical practice. More data is needed to evaluate the impact of the knowledge transfer from evidence-based studies on prescription’s trends during pregnancy.
2. Bruel H, Guillemant V, Saladin-Thiron C, Chabrolle JP, Lahary A, Poinsot J. Hemolytic anemia in a newborn after maternal treatment with nitrofurantoin at the end of pregnancy. Arch Pediatr 2000; 7:745-47.
3. Lockitch G. Maternal-fetal risk assessment. Clin Biochem 2004;37:447-49.
4. Conly JM, McEwen S, Hutchinson J, Boyd N, Callery S, Bryce E. Canadian Committee on Antibiotic Resistance report. Can J Infect Dis Med Microbiol 2004;5:257-60.
5. Vallano A, Arnau JM. Antimicrobials and pregnancy. Enferm Infecc Microbiol Clin 2009;27:536-42.
6. Santos F, Oraichi D, Berard A. Prevalence and predictors of anti-infective use during pregnancy. Pharmacoepidemiol Drug Saf 2010;19:418-27.
7. Roumie CL, Halasa NB, Grijalva CG, et al. Trends in antibiotic prescribing for adults in the United States--1995 to 2002. J Gen Intern Med 2005;20:697-702.
8. Guidelines. Antimicrobial Therapy - A Concise Canadian Guide 2007. Montreal: Prism, 2007.
9. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2007;CD000490.
10. Public Health Agency of Canada. Canadian Perinatal Health Report 2008. Ottawa, Ministry of Health.
11. Pitsouni E, Iavazzo C, Athanasiou S, Falagas ME. Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a metaanalysis of randomised controlled trials. Int J Antimicrob Agents 2007;30:213-21.12.
12. Norwitz ER, Greenberg JA. Antibiotics in pregnancy: are they safe? Rev Obstet Gynecol 2002;135-36.